Varicocele is a most common and surgically correctable cause of male infertility, for which varicocelectomy is the major treatment. Recent years have witnessed a lot of efforts devoted to the pathomechanism of varicocele-induced male infertility and rapid progress in researches on its cellular and molecular mechanisms, mainly including apoptotic abnormality and oxidative stress of germ cells. Meanwhile, researchers are coming to a consensus on the indications of varicocelectomy as well as the advantages and disadvantage of different methods of the procedure. This review updates the cellular and molecular mechanisms of varicocele-induced male infertility and its clinical therapeutic strategies.
Humans ; Infertility, Male ; etiology ; surgery ; Male ; Varicocele ; complications ; surgery

The incidence of varicocele in older adolescence varies from 12.4% to 17.8% with an average of 14.7%, similar to the incidence in adult males. Varicocele is associated with testicular growth arrest in adolescents. Varicocelectomy can reverse the testicular growth arrest. But without the testicular growth arrest, prophylactic surgery for every adolescent with varicocele is not advised. Surgery treatment should be offered to: 1. adolescents with testicular growth arrest more than 2 ml of difference between left and right testicle, 2. adolescents with abnormal semen analysis with high-grade varicocele, 3. adolescents with symptoms: pain, heaviness, swelling, 4. adolescents with bilateral varicoceles. Recurrence of the varicocele after surgery treatment can occur in 9% to 16% of adolescents. But rate of recurrence can be kept below 2% in adolescents treated by high retroperitoneal ligation with testicular artery ligation.
Adolescent ; Humans ; Incidence ; Male ; Recurrence ; Varicocele ; epidemiology ; pathology ; physiopathology ; surgery

Varicocele is the most common cause of male infertility and is generally correctable or at least improvable by various surgical and radiologic techniques. Therefore, it seems simple and reasonable that varicocele should be treated in infertile men with varicocele. However, the role of varicocele repair for the treatment of subfertile men has been questioned during the past decades. Although varicocele repair can induce improvement of semen quality, the obvious benefit of spontaneous pregnancy has not been shown through several meta-analyses. Recently, a well-designed randomized clinical trial was introduced, and, subsequently, a novel meta-analysis was published. The results of these studies advocate that varicocele repair be regarded as a standard treatment modality in infertile men with clinical varicocele and abnormal semen parameters, which is also supported by current clinical guidelines. Microsurgical varicocelectomy has been regarded as the gold standard compared to other surgical techniques and radiological management in terms of the recurrence rate and the pregnancy rate. However, none of the methods has been proven through well-designed clinical trials to be superior to the others in the ability to improve fertility. Accordingly, high-quality data from well-designed studies are needed to resolve unanswered questions and update current knowledge. Upcoming trials should be designed to define the best technique and also to define how to select the best candidates who will benefit from varicocele repair.
*Fertility ; Humans ; Infertility, Male/*etiology/surgery ; Male ; Urologic Surgical Procedures, Male/*methods ; Varicocele/complications/*surgery

OBJECTIVETo introduce two methods of laparoscopic varicocelectomy for the treatment of spermatic varicocele.

METHODSForty-five cases of spermatic varicocele were treated by video laparoscopic technique with two or three punch.

RESULTSAll the 45 operations were performed successfully, and no complications occurred during and after the operations.

CONCLUSIONSSpermatic varicocele is one of the most suitable indications for video laparoscopic surgery. The two-punch technique is more advantageous than the three-punch.

Adolescent ; Adult ; Humans ; Laparoscopy ; Male ; Middle Aged ; Urogenital Surgical Procedures ; methods ; Varicocele ; surgery ; Video-Assisted Surgery

Antegrade scrotal sclerotherapy is a simple and easy technique for the treatment of varicocele. The success rate varies between 87% and 95%. The initial reflux grade and the number of collateral vessels of the spermatic vein are the most important factors to predict the outcome of the technique. The postoperative complication rate is about 7% and the common ones are scrotal hematoma and epididymo-orchitis of slight severity. Testicular athrophy is a rare event (0.6%). This technique offers a considerable cost reduction compared to other therapeutic options currently available for varicocele.
Humans ; Male ; Postoperative Complications ; Sclerotherapy ; methods ; Scrotum ; surgery ; Varicocele ; surgery ; therapy

OBJECTIVETo compare the effect of transumbilical single-site single-port with that of transumbilical single-site double-port laparoscopic varicocelectomy in the treatment of varicocele in adolescents.

METHODSWe randomly assigned 80 varicocele patients aged 10 - 16 years to two groups of equal number to receive transumbilical single-site single-port and single-site double-port laparoscopic varicocelectomy, respectively. We compared the operation time, postoperative hospital stay, incisional pain, complications and satisfaction with the abdominal cosmetic outcomes between the two groups.

RESULTSAll the operations were successfully performed. The double-port group showed a significantly higher score on the Visual Analogue Scale than the single-port group (4.8 +/- 1.4 vs 3.6 +/- 1.1, t = -4.986, P < 0.01), but there were no significant differences between the two groups in the operation time ([29.8 +/- 4.2] vs [31.2 +/- 4.6] min, t = 1.383, P = 0.171), postoperative hospital stay ([1.95 +/- 0.7] vs [1.82 +/- 0.8] d, t = -0.784, P = 0.436), complications (0 vs 0) and scores on the satisfaction with abdominal cosmetic outcomes (4.6 +/- 0.6 vs 4.8 +/- 0.5, t = 1.253, P = 0.214). No recurrence, umbilical hernia, hydrocele and orchiatrophy were found in the two groups of patients at 6 months after operation, and no visible scar was observed on the abdominal surface.

CONCLUSIONWith strict surgical indications, single-site single-port and single-site double-port laparoscopic varicocelectomies have similar clinical effects in the treatment of varicocele, which leave no scar on the abdominal surface. Single-site double-port laparoscopy needs no special instruments and therefore is worthier of wide clinical application.

Adolescent ; Child ; Humans ; Laparoscopy ; methods ; Length of Stay ; Male ; Operative Time ; Umbilicus ; surgery ; Varicocele ; surgery

Varicoceles is the most common identifiable cause of male infertility, and varicocele repair is a major means for the treatment of the disease. Conventional techniques of varicocele repair including Palomo operation, open inguinal varicocelectomy and laparoscopic varicocelectomy have a relatively high rate of postoperative hydrocele formation, varicocele recurrence and testicular artery injury. Recently, microsurgical varicocelectomy has gained a worldwide application in the treatment of varicocele, which can preserve the testicular artery and lymphatic vessels ligate all the spermatic but vasal veins and significantly lower the incidence of the complications. It can improve the semen parameters of male infertility patients and increase the pregnancy rate in their female partners. It can also improve the semen parameters of the patients with non-obstructive azoospermia or severe oligoasthenospermia. Nowadays microsurgical varicocelectomy has become the "golden standard" for the treatment of varicocele.
Humans ; Infertility, Male ; surgery ; Male ; Microsurgery ; methods ; Treatment Outcome ; Varicocele ; surgery

OBJECTIVETo evaluate the clinical effects of laparoscopic occlusion of the internal spermatic vein with Hem-o-Lock clips and retroperitoneal ligation of the spermatic vessel (Palomo procedure) in the treatment of primary varicocele.

METHODSWe included in this study 42 varicocele patients treated by laparoscopic occlusion of the internal spermatic vein with Hem-o-Lock clips (Hem-o-Lock group) and another 38 treated by Palomo procedure (Palomo group). We recorded the operation time, intraoperative blood loss, hospital stay, bowel function recovery time, post-operative complications, as well as such seminal parameters as sperm concentration, sperm motility, sperm abnormality and the percentage of grade a + b sperm 6 months after surgery. We measured the interior diameter and reflux time of the spermatic vein and the ratio of flow velocity to the diameter using color Doppler flow imaging (CDFI), and observed the disappearance and recurrence of clinical symptoms.

RESULTSIntraoperative blood loss was markedly less and the operation time, postoperative hospital stay and intestinal function recovery time significantly shorter in the Hem-o-Lock than in the Palomo group (P<0.05), but there were no statistically significant differences in the incidence of postoperative complications (P>0.05). Six months after surgery, seminal parameters and the results of CDFI were significantly improved in both the Hem-o-Lock and Palomo groups (P<0.05), but with no significant difference between the two (P>0.05). No recurrence was found in either group at 18 months.

CONCLUSIONBoth laparoscopic spermatic vein occlusion with Hem-o-Lock clips and Palomo procedure can improve the semen quality and relieve the clinical symptoms of primary varicocele patients, but the former is even more preferable for its shorter operation time and hospital stay, less intraoperative bleeding, fewer complications, better clinical outcomes, and lower rate of recurrence.

Adult ; Humans ; Laparoscopy ; Male ; Treatment Outcome ; Varicocele ; surgery ; Vascular Surgical Procedures ; methods ; Veins ; surgery ; Young Adult

OBJECTIVETo evaluate the one-hole method for high ligation of the internal spermatic vein by embryonic natural orifice transumbilical laparoscopy.

METHODSWe used the one-hole method for high ligation of the internal spermatic vein by embryonic natural orifice transumbilical laparoscopy in the treatment of 15 cases of varicocele, 13 in the left and 2 in the right side, and appraised the treatment results by follow-up 1 month after the surgery.

RESULTSAll the operations succeeded and no complications developed. The average operation time was 28 minutes and the mean hospital stay was 4 days. Symptoms were significantly relieved in all the patients and the scars were inconspicuous at follow-up.

CONCLUSIONThe one-hole method is a novel option for high ligation of the internal spermatic vein by embryonic natural orifice transumbilical laparoscopy in the treatment of varicocele. It is recommendable for its advantages of simple procedure, less pain, few complications, quick recovery, mini-invasiveness and cosmetic acceptability.

Adolescent ; Adult ; Humans ; Laparoscopy ; Ligation ; methods ; Male ; Umbilicus ; surgery ; Varicocele ; surgery ; Young Adult

In this review, we tried to systematize all the evidence (from PubMed [MEDLINE], Scopus, Cochrane Library, EBSCO, Embase, and Google Scholar) from 1993 to 2021 on the predictors of microsurgical varicocelectomy efficacy in male infertility treatment. Regarding the outcomes of varicocele repair, we considered semen improvement and pregnancy and analyzed them separately. Based on the 2011 Oxford CEBM Levels of Evidence, we assigned a score to each trial that studied the role of the predictor. We systematized the studied predictors based on the total points, which were, in turn, calculated based on the number and quality of studies that confirmed or rejected the studied predictor as significant, into three levels of significance: predictors of high, moderate, and low clinical significance. Preoperative total motile sperm count (TMSC) coupled with sperm concentration can be a significant predictor of semen improvement and pregnancy after varicocelectomy. In addition, for semen improvement alone, scrotal Doppler ultrasound (DUS) parameters, sperm DNA fragmentation index (DFI), and bilateral varicocelectomy are reliable predictors of microsurgical varicocelectomy efficacy.
Female ; Humans ; Male ; Pregnancy ; Infertility, Male/surgery* ; Microsurgery ; Semen ; Sperm Count ; Sperm Motility ; Varicocele/surgery*